Bahan dan Alat Repair Ruptura

Perinei

Dr. Tyas Priyatini, SpOGDivisi Uroginekologi Departemen Obstetri

Ginekologi FKUI-RSCM

Membutuhkan:Pengenalan anatomi yang baikPengetahuan klasifikasi derajat robekan perineumKamar Operasi dengan pencahayaan yang baikAlat dan bahanKeterampilan penjahitan Perawatan pasca operasi yang baik

Penjahitan robekan perinei akut

Sterilitas Meja operasi yang dapat disesuaikan Kelengkapan instrumen Pencahayaan yang baik Kasus robekan perineum grade III-IV

Kamar Operasi

• Retractor Weislander’s• Forceps gigi (fine & strong)• Needle holder (small and large)• Forceps Allis (4)• Forceps arteri (6)• Gunting McIndoe• Gunting pemotong jahitan• Spekulum Sims• Retraktor dinding samping dalam vagina• Forceps pemegang kasa

Instrumen untuk Reparasi Robekan Perineum :

• Tampon• Kapas besar• Povidon Iodine• Lidocain 1% (untuk ruptura perinei

grade I-II)

Bahan-bahan yang dibutuhakan

PEMILIHAN BENANG BERDASARKAN JARINGAN

SUTURE TYPES

TENSILE STRENGTHRETENTION in vivo

ABSORPTION RATE

TISSUE REACTION

Surgical GutSuture

Chromic Individual patirent characteristics canaffect rate of tensile strength loss

Absorbed by proleolyticenzymatic process.

Moderate

Coated rapid (polyglactin 910)Suture

Braided Approximately 50% remains at 5days. All tensile strength is lost atapproximately 14 days.

Essentially completebetween 42 days.Absorbed by hydrolysis

Minimal to moderateacute inflammatoryreaction

poliglecaprone 25Suture

Monofilament

Approximately 50-60% (violet: 60-70%) remains at 1 week. Approximately 20-30% remains at 2 weeks.Lost within 3 weeks

Complete at 91-119days. Absorbed byhydrolysis.

Minimal acuteinflammatory reaction

polyglactin 910Suture

Braided Approximately 75% remains at 2weeks. Approximately 50% remains at 3 weeks, 25% at 4 weeks.

Essentially completebetween 56-70 days.Absorbed by hydrolysis

Minimal acuteinflammatory reaction

polydioxanoneSuture

Monofilament

Approximately 70% remains at 2 weeks.Approximately 50% remains at 4 weeks.Approximately 25% remains at 6 weeks

Minimal until about 90thday. Essentially completewithin 6 months Absorbedby slow hydrolysis.

Slight reaction

Robekan mukosa anus: polyglactin 910 no 3-0

Otot sfingter ani interna : polyglactin 910 atau polydioxanone no 3-0

Otot sfingter ani eksterna: polyglactin 910 atau polydioxanone no 2-0 atau lebih besar

Otot perineum: polyglactin 910 atau polydioxanone no 3-0

Mukosa vagina dan perineum: polyglactin 910 absorbsi cepat no 3-0

Materi benang yang direkomendasikan

Dilakukan di Eropa and the USA Membandingkan benang sintetik yang diserap

(standard polyglactin 910 atau polyglycolic acid) dengan catgut

Hasil: materi benang sintetik yang diserap secara signifikan menurunkan nyeri perineal jangka pendek (OR 0.62,

95% CI 0.54 to 0.71). penggunaan analgesia dalam 10 hari yang lebih

rendah (OR 0.63, 95% CI 0.52 to 0.77) Angka dehisens yang lebih rendah (OR 0.45, 95% CI

0.29 to 0.70) no difference in the amount of dyspareunia

experienced by women

A Cochrane systematic review of 8RCT

TERIMA KASIH